An important component in the treatment of anorexia nervosa (AN) is the evaluation and management of its endocrine complications, including functional hypogonadotropic hypogonadism and increased fracture risk. The body's adaptive response to chronic starvation results in many endocrine abnormalities, most of which are reversible upon weight restoration. A multidisciplinary team with experience in treating patients with AN is critical to improving endocrine outcomes in patients with this disorder, including in women with AN who are interested in fertility. Much less is understood about endocrine abnormalities in men, as well as sexual and gender minorities, with AN. In this article, we review the pathophysiology and evidence-based recommendations for the treatment of endocrine complications in AN, as well as discuss the status of clinical research in this area.
Keywords: Amenorrhea; Anorexia nervosa; Endocrine complications; Low bone density.
Endocrine complications are common in anorexia nervosa (AN). Examples include absence of menstrual periods in women, low testosterone levels in men, and low thyroid hormone levels, all of which are considered adaptive to the state of undernutrition. Low bone density and increased risk of fractures are also common complications. In women, weight recovery and restoration of menstrual periods are important treatments for low bone density. Less is known about the treatment of endocrine complications in men with AN. In this article, we review the causes and treatment of endocrine abnormalities in AN.
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